Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)

Paul,

Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,

A

Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?

G

Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.

Lupus

I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul

Depression


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?

9,730 Comments.

  1. Hi Paul,

    I thought you recently wrote something about boiling beef bones for an hour and discarding the water to get rid of excess iron, but I can’t find the post. Perhaps someone else wrote it. At any rate, wouldn’t that also get rid of calcium and other minerals? And, if calcium taken at the same time as iron minimizes iron absorption, wouldn’t this be an unnecessary step?

    • Hi Cathryn,

      Calcium is in mineralized collagen so it doesn’t come out easily. Blood is a surface contaminant. So basically rinsing/cleaning/simmering the bones quickly in pure water will clear out the blood / heme iron without taking away nutrients. Then replacing with fresh water, this time with a bit of acid, for a longer simmer will leach calcium out. There’s a lot of calcium in bones and it comes out gradually.

    • Look under soups for Bone Broth Revisited

      Ellen

  2. Dear Paul,

    In August of 2011 my THS was 1.94 and in October of 2011 I began your diet (was on a very low starch paleo diet of a couple of years before I started PHD). I got my thyroid tests again today and my THS is 1.32. I understand from your book that this is a good thing!

    My free T3 is 3.5 and free T4 at 13. I am not taking iodine yet but am considering it. I’m not sure if these numbers point to hypothyroidism or not.

    I also have low iron reserves 49 (range 31-300).

    My doctor said I should pick up some iron supplements but wanted to know what the PHD approach is to low iron.

    Many thanks

    • Hi Amy,

      Your thyroid numbers are excellent! I would still recommend at least a small dose of iodine, say 225 mcg, just to be sure there is no deficiency. It might be possible to do even better.

      If iron reserves means ferritin, 49 is actually an excellent number. The upper end of that reference range is much too high. I wouldn’t supplement iron unless you have some signs of iron deficiency. I would just eat beef, beef or lamb liver (1/4 lb) and kidney (1/4 lb) once a week, and shellfish. However, if you do have any symptoms of iron deficiency anemia, or if other measures of iron status were low and you are menstruating or pregnant, then I would experiment with supplements.

  3. Perhaps this is a rare question, but here goes: I have been on the Paleo diet for about 18 months with about the last 3 on the PHD version. One change I made was cutting back on the amount of nuts I was eating (too much Omega 6). To make up for 3 oz of nuts, I am substituting coconut oil or adding lots more ghee to whatever I am cooking. Since doing that, i’ve lost about 5 lbs, and I really don’t want to go any lower. I eat about 2800 calories a day, and I stay hungry most of the day. I’d like to gain the 5 lbs back. (I’m 6′ 3″ and weigh about 170). Any weight gain suggestions?

  4. Hello,

    As a senior in college who is very much so interested and obsessed with the health and nutrition world but a bit confused as to where to go after college, I was looking for a bit of advice. I was thinking pharmacy school but I hate everything about drugs and the industry. I would love to be able to study the kind of research you spread on here (so perhaps molecular biology?) or spread the word of real health. However, becoming a dietician seems muddled in the path of conventional wisdom which is not what I want to be forced to tell people. What are your thoughts on what the next best path for me to take would be? Thanks

    • Hi Jared,

      I don’t know. Perhaps a good way would be to meet with people who do the kinds of work you are considering and talk to them about what their work is like. Everyone has to find the right fit for them.

    • Naturopathic or Chiroprctic Medical schools will give you the greatest non-pharmaceutical medical education you can get, you’ll be a real doctor and will love the work you do. Call me if you like. I’ve been a nutritional/homeopathic chiropractic physician for 34 years. 415-847-5020

  5. Hi Jared,

    As someone who has made these considerations before I thought I would give you a few ideas. If nutrition is what you’re interested in, but don’t want to be a dietitian or some such thing, I would recommend biochem… which would allow you to understand the chemical processes that occur in the body. Biochem would be a sort of meta focus and obviously you would have to specialize a little, but any good university mentor should be able to guide you. Another option I considered is med school to become a family practitioner. The FP’s are in the trenches everyday with their patients and have a great opportunity to treat them as a holistic being which would obviously include nutrition. Additionally, FP’s are in great demand.

    Then, if you’re more interested in the disease process you could consider molecular bio, or maybe cancer cell bio or pathophysiology. But with these things realize there are few opportunities I found outside of bench work or academia.

    Personally, I ended up opening a restaurant, but hopefully you will have better luck turning your health and nutrition passion into a career 😉

    Best,
    Lindsay

  6. Hi Paul. I wonder if you may have any recommendations for the following (rather minor) issues:

    1) Chapped lips. Even in the summer, I need to apply chap stick and can get rather uncomfortable if I forget it and don’t apply it for a long period. As well, when I do forget it and lick my licks for relief, they taste bitter.

    2) I get tiny whiteheads (always around my eyes on the inferior and inferior temporal aspects, if that makes any difference).

    I have started trying much harder to get my 1/4lb of liver weekly, and am hoping perhaps it may make a difference. I’m surprised how quickly the taste for liver has grown on me!

    Thanks Paul. You are truly a Saint for what you do here.

  7. Paul, I got a bottle of Prolamine, but the pills are 3mg. You recomend starting at 225mcg. Should I cut those pills?

  8. Paul, what’s the best way to cook egg yolks for those of us who aren’t comfortable eating raw eggs? I want to avoid overcooking them. Is heating them up with other food in the microwave okay? What about making them hard boiled?

    Is it important for dairy to be grass-fed or is regular organic dairy healthy?

    Thanks 🙂

    • Hi Maddie,

      Microwaving is fine, hard-boiled is fine. You just want a gentle heat (which boiling is). I microwave mine, usually in broth and coconut milk along with potato or rice, meat, and veggies.

      Grass-fed dairy is more nutritious but organic dairy is fine.

  9. Hi Paul,

    I’ve recently managed to persuade both of my parents to IF for 16hr everyday and so far they love it, they’re around 60 years old and are lucky enough to not have any health problems at the moment. I was just wondering if there are any potential detrimental effects to fasting everyday for people of their age and if there’s anything to look out for? i’ve told them to eat if they feel strong hunger consistently (i know you’ve talked about this before) and to just get their health to a point where they fast comfortably.

    thanks for all of your and Shou-Ching’s work 🙂

    • Hi Adam,

      I don’t think there are any ill effects as long as they eat enough in the remaining 8 hours. You’re quite right, if they feel hunger during the fast they should eat something. They should try to eat nourishing foods as well.

  10. Dear Paul, i was just reading your chapter about proteins-limiting proteins makes much sense-but why throwing away egg white to limit protein intake? if you eat three eggs a day, there is an intake of 3,6 g protein per egg white-something like that. and omega-6 is mostly gone with cooking/frying. there is still much space left to get your daily protein intake…or did i understood it wrong? i just think its a waste to throw away egg white.

    Warm regards, Gregor

    • It’s not necessary to throw them away, it’s just what I do. Egg white proteins can be immunogenic and I developed a mild sensitivity to them during my various health travails 5-6 years ago. Also I like meat but prefer a lower protein diet, so it just works out well for me to toss the egg whites.

  11. Hello Paul, I just discovered your site and you have thrown yet another dietary method into the mix. I have been (mostly) vegan for about a year but a recent mediocre blood panel and poor endurance training results led me to look at Paleo. Over the last week I have introduced meat, chicken and fish.

    I have also been newly influenced by Gary Taub (very low carb) and William Davis (no wheat) and have been trying to move in that direction. I still love my green smoothies in the morning and lot’s of fresh fruit and vegetables though so my carbs are pretty high.

    I was eating basmati rice everyday but I’ve cut that out as per Gary Taub and almost all other “starchy carbs”.

    Your recommendations are very different than most Paleo that I’ve found, especially about things like potatoes. I will read your book and maybe give it a try. You certainly have done your research.

    I have an odd problem that you might be able to shed some light on. Several years ago I had my gall bladder removed. Ever since that time I cannot eat any type of cooked egg!! I get a terrible pain in the upper stomach area (I guess the area where my gall bladder was), like a super indigestion. Eventually the eggs pass through that area (about 30mins) and I all is well.

    Have you ever heard of this? I have yet to try egg yolks or whites on their own or even a raw egg in my smoothie. I seem to recall a raw egg was OK when I tried it some years ago.

    Thanks for your great Blog.

    • Hi David,

      I think it’s much better to eat some carbs. Arguments can be found in our book. I hope you do read it.

      I’m not sure what’s causing the egg intolerance. It’s either some impaired digestion of egg lipids due to limited release of bile, or a sensitivity to egg proteins resulting from a leaky gut.

      To test for sensitivity, try egg yolks without the whites. To test the other theory, try taking an ox bile supplement with your eggs and see if that helps.

      Some people do report similar issues with egg yolks after gallbladder removal, eg http://boards.straightdope.com/sdmb/archive/index.php/t-179724.html. I don’t know how common it is.

      • Thanks Paul. Today I tried one raw egg in my green smoothie and had a very mild reaction. Nothing for an hour or so and then some mild indigestion later on but certainly nothing like the 2 egg omelette incident. Thanks again and I will be reading everything you are putting out. 😯

  12. Hi Paul. How many servings a day of vegetables do you suggest? And how many of them should be fermented? Thanks, Barb

    • Hi Barb,

      Eat vegetables to taste. Let the flavor of foods be your guide. Meat and starch alone would get boring, but don’t eat more vegetables than you’ll enjoy.

      Some of them should be fermented, but it doesn’t really how much. Again, let taste be your guide. If you need something in a particular food, usually it will taste especially good to you.

      Best, Paul

  13. Paul, I love your book and I’m purchasing a couple more copies for family members that are currently having health issues.

    I’ve been following PHD for a few months now (with the exception of supplementation and circadian rythim protocol) and I’m still having a number of negative symptoms:

    -chronic perennial rhinitis (sinus pressure and congestion)which is made worse only after drinking alcohol. I have never noticed my symptoms worsening or being triggered from any other allergens.
    -chronic post nasal drip with thick but clear mucus (I never noticed certain foods causing this and I’ve cut out all dairy except for butter)
    -restless leg syndrome (mostly at night)
    -swollen glands and sensitive arms (due to zoster virus flare up mostly when I’m stressed or lacking sleep)
    -mild depression and fatigue

    Do you think any of these are linked? Should I incorporate the supplementation aspect of the diet to see if it helps with my symptoms? Is there specific tests that I should have done such as testing for bacterial or fungal infection? Do you have any further recomendations of what I can do to resolve my symptoms? Thanks again for your work!

    Jon

    • Hi Jon,

      I would say the next step is to start experimenting with nutrition — nourishing foods and supplements.

      Rhinitis could be fungal infections which may be due to copper and vitamin A/D/K2 deficiencies. Restless leg syndrome could be magnesium or other electrolyte deficiencies.

      On the other hand they could be related to the viral infection.

      However, if you improve nutrition everything should improve. Be sure to follow the new nutritional supplementation advice, not the advice in the original book.

      Best, Paul

      • Thanks Paul, I plan on buying your new book, but is the updated supplementation recomendation the list on your site?

        I assume I should also be following the immune enhancing strategies and circadian rythim protocol?

        Regarding vitamin A/D supplementation, is fermented cod liver oil acceptable? I know your not a big fan of fish oil, just wondering if the fermentation process provides stability?

        Thanks again.

        • Hi Jon,

          The updated supplement recommendations are listed at the top of the Supplement Recs page, but I haven’t updated the Amazon purchase links yet.

          Yes, the circadian rhythm and immune enhancement strategies are good things to do, even for healthy people, but especially important for those with health issues.

          Fermented cod liver oil is acceptable but not recommended. I think it’s better to get vitamin A from liver and egg yolks and fish oil from fish. I’m not convinced the fermentation is beneficial; it might be harmful.

          Best, Paul

  14. Here is an interesting repport on Health Care in America. The media grabbing headline of course is $750 billion wasted on Healthcare but there is a lot of interesting information and ideas for improvement in the report: http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx

  15. Dear Paul,

    you recommend the moderate intake of dark chocolate also for magnesium and even during intermittent fasting. we are very happy about it:) there is some very good 85% fair trade, organic chocolate around and also some with no suggar at all. what about the 85% -it still contains low doses of suggar-thats allright, i mean ok with one/two bits a day-thats what my taste tells me. just worried about regular intake of fructose-or is it even lower then in apples?

    thank you anyway for being never tired answering all these questions!
    warm regards,
    Gregor

  16. Hi Paul,

    About a year and half ago, I was in near-perfect health, with the exception of a vitamin D deficiency. Then, I went on a vegan diet and increased my already strenuous workouts to about 3 grueling hours a day. After roughly six months, I began feeling fatigued. My doctor tested my thyroid levels, which had been fine only six months earlier, and my T3 and T4 were both horribly low. I was put on T3 supplementation with cytomel. At my two month recheck, my T3 had dropped even further, so my doctor added compounded thyroid to the mix. After two months on both cytomel and compounded thyroid, my T3 increased to the low end of the normal range. Thereafter, it began falling again and is now the lowest it’s ever been, even though I’m still taking both thyroid medications. My doctor, baffled by my body’s lack of response to medication, did some further testing and found my DHEA and testosterone levels to be half what they should be. My adrenal gland is under-functioning as well. At times, the fatigue has been so bad, I’ve been unable to drive and have had difficulty standing or walking. For the last two weeks, I’ve been on adaptogens and DHEA, per doctor’s  orders, in addition to a low dose of prescription testosterone and weekly b12 injections. Whether it’s the new medication and supplements or the fact that I’ve been eating according to your suggestions for about ten days or, most likely, a combination of both, I’m feeling better than I’ve felt in months. I’m curious to see the results of my next round of blood work. 

    Thank you for all the information you provide. It’s changing my life!

    • good to hear you doing better Allison,
      out of interest, did they test your TSH as well?
      just wondering if that was within range during your troubles.
      A lot of Doctors rely on TSH alone & if that is within lab range, they will never test t3, t4 (or ft3, ft4), even when patients list all their (hypothyroid) symptoms.

    • Hi Allison,

      It’s great that you’ve adopted our diet! Diet is so important for the thyroid and adrenals.

      It generally takes months to recover from thyroid-adrenal issues, so you’ll have to be patient, and keep trying to do everything right. Keep us posted!

      Best, Paul

  17. Darrin, it’s interesting you should ask about my TSH. It never went high, even though my T3 was so low. I’m fortunate my doctor isn’t one who relies only on TSH. Ever since I started taking compounded thyroid (so all but the first two months since diagnosis) my TSH has actually been low. The numbers are all a mess!

  18. Hi Paul,

    I would very much appreciate your advice about my husband’s iron levels. They are:
    Iron umol/L 19
    Transferrin umol/L 28
    TFN Satn 34
    Ferritin ug/L 356

    He is 68, has a severely degenerated mitral valve and the surgeon’s opinion nine months ago was that immediate surgery was necessary. After just over a year on PHD he feels great and has no symptoms other than atrial fibrillation. He refuses to have the operation while he feels so well, has plenty of energy and is never breathless, not even when walking fast up steep hills or doing hard physical work.

    He has refused all blood thinners, even baby aspirin, which infuriates his doctors. He takes 90mcg per day of Vit K2, as you recommended, as well as 500mg of Vitamin C and 400mg of magnesium twice a day. He eats 1oz of liver per day, which he believes is vital for his continued health and he doesn’t want to take a multi-vitamin. He cannot be accepted as a blood donor due to his heart condition and his doctor won’t prescribe a therapeutic phlebotomy.

    His blood pressure and blood sugar are very good; his Vitamin D level is 131nmol/L; his HDL cholesterol has improved from 1 to 1.8 mmol/L since going on PHD; Trig is 0.6 mmol/L and total cholesterol is 5.8mmol/L. Needless to say he won’t be taking his doctor’s advice about cholesterol either.

    He has a high stroke risk but is convinced that PHD (we follow all your recommendations and never cheat) will enable him to put off the surgery for years, if not for ever. I can’t help worrying as I have read that Barlowe’s Disease results in either surgery or death within ten years and it was about that long ago that he started experiencing severe fatigue, which has miraculously almost disappeared since going on PHD.

    I can never thank you enough for all your brilliant work which has helped my whole family. I hate to think where we would be if I hadn’t found you.

  19. Hi Francesca,

    It’s great that he’s feeling better! I agree with him that he should avoid surgery and drugs as long as possible and proceed with diet, light exercise, circadian rhythm enhancement (outdoor sun exposure and light activity during the day, sleep in a darkened room and wake naturally, not much light or TV exposure at night).

    His cholesterol and vitamin D numbers are perfect. Bravo!

    Too bad about the phlebotomy, that might help him a great deal. Maybe if his symptoms continue to recede they’ll allow blood donation again.

    He may be taking more magnesium than is desirable, although if his kidneys are healthy the excess will be excreted without harm. Magnesium should be balanced with calcium so he should optimize calcium. I think a bowl or half-bowl of bone broth per day will achieve that.

    Possibly supplementing some B12 may accelerate healing of the heart. We’ve put our new supplement recommendations up at the top of the supplements page, check those out.

    Our new edition is expanded and will have more advice that should help him, especially in the micronutrient and lifestyle sections. Please keep me posted on his progress, and I wish you both the best!

    Best, Paul

  20. Hi Paul,

    Thank you for your amazingly prompt reply. We think we will try harder to find a doctor who will prescribe a phlebotomy. Could you please advise what he should attempt to get his iron/ferritin levels down to?

    Re the 800mg per day magnesium supplementation and calcium balance – he has about three bowls of bone broth a week but he also consumes about half a litre of creamy Jersey unpasteurised milk each day. I know that’s not PHD and am always telling him to cut back on it but he loves it. He also has quite a lot of butter and some cream and coconut oil but his weight is ideal. Would he be better off cutting back on milk and cutting the magnesium supplement to 400mg?

    Thank you so much for your response, it’s great to know that you think he is doing the right thing.

    • Hi Francesca,

      I would say that for a healthy person 50-80 is a healthy ferritin level. For those with infections/inflammation higher levels may be needed to avoid anemia. Therefore it is necessary to do a full iron panel to evaluate iron status, especially in an older person with heart disease.

      The milk and bone broth are great, so his calcium status should be excellent. Just keep on doing what you’re doing!

      The magnesium – he might want to test if he does fine on 400 mg/day, preferably in divided doses taken with food. As I said if his kidneys are healthy the extra magnesium shouldn’t be a problem, but too much magnesium might strain the kidneys. If he gets signs of magnesium excess or kidney non-performance like swelling at his feet, then I would cut back. Be familiar with symptoms of magnesium excess: http://www.livestrong.com/article/379016-signs-and-symptoms-of-too-much-magnesium/

      Best, Paul

      • Wow, I think I’ve been taking too much Magnesium at times and sometimes get erratic heart rhythms and some feet swelling, but never made the connection. I think I also tend to be lowish on calcium and so balance is probably off.

        Magnesium helps constipation and I haven’t been able to improve it with other recommendations.

    • Hi Francesca,

      Let me add a qualification: I do not know his particular situation or what surgery can do, so I can’t say whether he should avoid surgery or not. I just think on general principles that one should strive to give natural healing a chance, see if it’s working, and then appraise the situation.

      If there is an ongoing risk of failure/stroke, and natural healing is not healing the valve, then he should carefully consider his options.

      I don’t wish to make it seem that I am trying to act as his doctor. I hope you understand where I am coming from.

  21. Hi Paul,

    Thanks again and I’m sorry to keep bothering you but I’m worried that if 50 – 80 is a healthy ferritin level then my husband’s level of 356 must be very unhealthy. His iron level is 19. It seems that he would need to have blood taken regularly to get down to a healthy ferritin level. Do you think such a high ferritin level could further increase his stroke risk?

    • Hi Francesca,

      High iron levels are a risk factor for chronic infections and for some glucose- and oxidation-related metabolic issues. As such they could increase stroke risk. I don’t think you should panic, as in the absence of infections or an unhealthy diet/lifestyle creating metabolic risk it shouldn’t be that harmful. Still, best to take care of it if you can.

      This study suggests that iron levels predict bleeding risk after a stroke, which correlates with severity: http://www.ncbi.nlm.nih.gov/pubmed/21999175 – ferritin above 171 is associated with symptomatic hemorrhagic transformation of strokes. That may be because high ferritin occurs in infections, rather than because the iron excess is directly causing hemorrhage. But to my knowledge there’s no known health benefit and some risk to having such high iron levels.

      Yes, he’ll probably need to give blood regularly, say once every two months, and it might take a year to get levels down to normal. I would monitor them regularly. Iron deficiency anemia is also a risk factor for stroke, so you want to make sure levels remain normal.

      Best, Paul

  22. Hi Paul,
    What’s the best strategy for tick parasites (like Lyme, etc) as far as diet, to help the body’s immune system fight the parasite? I know antibiotics are a must if it’s Lyme, but wanted to know what’s good to do and not do if tick parasite is suspected.
    This morning I discovered red circular area (about 3 in diameter) on my back. Last week there was a small itchy bump there but I didn’t see a tick (I know some of them are too small to see though). And we have been hiking and camping a lot recently and I did pull 5 tiny tiny ticks off me after our last hike but those were on my ankle and theres no rash there.
    Anyway,I am going to a doctor but I might have to wait until Monday. So, in the meantime, what’s a good idea as far as specific foods and extra supplements, just in case it is some kind of tick parasite? Any thoughts?
    Thank you!!

  23. Hi Paul,

    I was wondering if there is anything outside of oxygen therapy that a person can do for chronic carbon monoxide poisoning? My sister has been living in a house for the last three years with toxic levels and she got it from a furnace. When the furnace broke the repairman tested it and it was so bad that by law he had to shut the gas to it off. She has experienced most of the effects of CO poisoning, anxiety, depression, fatigue, headache, etc. She even began seeing a psychiatrist for the anxiety and a doctor for the headaches and vertigo. Are there any supplements you recommend? She does not follow the PHD but I think she would be open to making some changes if she could feel better. Thank you.

    • Hi Louise,

      I haven’t thought about it much, but (a) I do think she should switch to PHD, and (b) I’d also check on status of iron (ask her doctor for an iron panel, eat beef and shellfish or give blood until it is optimized), copper (eat 1/4 lb beef or lamb liver per week), thyroid status, and general health indicators.

      I wouldn’t automatically assume that she’s still suffering CO poisoning. It could be that she suffered an injury during the CO poisoning and it hasn’t healed yet. So good general health practices and diet is what’s called for.

  24. Hi Paul,

    I read in your book that fructose should not be consumed with PUFA.

    Are Coconut oil, Tallow, Beef, Fish, Chicken, or Butter OK to be eaten with fructose or are they too high in PUFA?

    Thanks for a very informative book and website,

    JC

  25. Around the Web: Back to School Edition | Perfect Health Diet - pingback on September 8, 2012 at 5:00 pm
  26. I appreciate the updates on the new book. It’s exciting to anticipate its arrival. Have pre-ordered ten copies for Christmas shopping and will add to that a number of Kindle editions. Any possibility of a midnight release and thousands of PHD’ers waiting in line in the dark at a local bookstore? 🙂

    Paul, or anyone who knows, what frequency of Metametrix testing is recommended? After my treatment period I do hope to have test to see the effectiveness of the treatment. But then, after that, is this a once every ? years test?

    Also, what’s all this about H. Pylori possibly being one of those members of a normal gut flora. Metametrix says that complete eradication of it can result in esophageal issues.

    Listened to the fat burning man interview with Paul. Excellent, as always.

    • Thanks, Lana.

      There really isn’t any science to tell us how often you should get a stool test. Most doctors would say if you’re healthy you don’t need one. If you had a test, it found something and you treated it, it makes sense to test again to see if it’s gone.

      I personally believe in diagnostic testing of healthy people to find problems before they generate symptoms. But it’s not standard.

      I personally don’t believe that H pylori is a normal part of gut flora. I haven’t seen any convincing evidence of it. And genetically it seems to have originated as a human pathogen fairly recently.

  27. Hi Paul,
    You made a comment recently about fermented cod liver oil. I’m sorry I can’t find it, but I recall you saying that it may be detrimental. It seems to be so highly recommended in the Paleo practitioner community so now I’m confused. Did I hear/read your opinion correctly? Is your reason to not take this product the same as why you don’t recommend taking fish oil?

    I like lana’s midnight release comment…I’ll be in line too. Your book is one reason I will look forward to winter coming this year. Fantastic idea about Christmas gifts.

    • You can find anything on this site by going to Google and using the following structure:

      “fermented cod liver oil” site:perfecthealthdiet.com

    • Hi Heidi,

      Yes, I did a series on how oxidative stress + DHA + vitamin A = bad news. Fermentation generates oxidative stress and cod liver oil is loaded with vitamin A and DHA. I’m suspicious of it.

  28. Hey thanks Peter! I appreciate that tip.

    For anyone else who’s wondering, the explanation is in the “Food Fortification: A risky Experiment” post from back in March of 2012.

  29. Hi Paul,

    Thanks so much for the advice and the study. We don’t expect diet to heal the valve but if it can maintain him at this level, feeling so well and energetic, with blood pressure, blood glucose, cholesterol, Vitamin D, and ideal weight, then we think it’s better to take the risk of stroke.

    The valve is beyond repair and a replacement valve comes with a life expectancy of seven to twelve years, usually around ten, and the many risks involved in the operation and three months afterwards on heaps of drugs. He is having six monthly echo-cardiograms and will have the operation when the heart stops compensating and starts to enlarge. The doctors are very surprised that his heart is still compensating so well.

    Thanks a lot for that study, we can use that to persuade the doctor to prescribe phlebotomy. It is not possible to get information like that from anyone else and we are very grateful. We know there is a risk either way but we feel that we are on the right track and that gives us peace of mind. Thank you and we will keep you posted.

    • sometimes valve malfunction is because they no longer fit into the opening they close. B vitamins have been said to nourish the fibrous matrix of the heart and help to change its shape, from sagging due to deficiency to upright. The valve then fits properly and all is well. Those who talk about this recommend whole food based vitamin Bs (just so you know). Cyrus

  30. Hi Paul,

    i was wondering if you could write something about polyamines in the diet. They seem to be a double-edges sword – on one hand they seem to encourage cellular growth and repair and offset age-related decline in some animal models, but on the other hand they have also been linked to tumour growth and joint pain. Frozen, canned, fermented, and stale foods seem to be higher in them, and certain food groups (poultry, certain red meats, dairy, and fruit) seem to be higher in them than other groups. Studies show that cultures typically associated with being healthier such as Japanese have about half the polyamine intake as European cultures. No-one seems to have talked about this interesting topic, so maybe you could be the first! 🙂

  31. Hi, I have a question about your pregnancy macro ratios. This is my first healthy eating pregnancy, the previous three were vegetarian carb loaded. In the last two years I’ve switched to a paleo type diet, with raw milk as I have my own cows, and the pregnancy is going much smoother with much less weight gain. On to my question, of course my midwife is saying more carbs and more protein. I took a Bradley class when pregnancy with my first and they recommend at least 100gms protein, more if you work out. I lift heavy weights and do sprint type cardio a couple times a week. I’m just wondering about the 10% protein, 20% carbohydrate recommendation you have for pregnant women, that’s going to be 50 grams protein a day for a 2000 calorie diet, right now I seem to be eating right around 1600 calories without any hunger, so that’s be even less for me. My theory is that with a high nutrient diet you don’t need as many calories, according to the standard recommendations I should be eating at least 2300 calories a day, I don’t think that’s remotely possible for me. Right now my ratio’s are about 60% fat, 25% carbs, 15% protein. So I guess my question is, is your recommendation of 10% protein, 40 grams a day or so, adequate for an active, weightlifting pregnant person? And am I right in thinking that I need less calories because of higher nutrient density than the SAD diet recommendations? Thanks for your time, Marie

    • Hi Marie,

      10% protein is a minimum, 20% protein a maximum, for pregnant women. Whereas for non-pregnant the tolerable range would be 10% to 30%.

      For carbs we recommend more like 30%. So a typical diet would be 30% carb, 15% protein, 55% fat.

      I agree that with a nourishing diet you don’t need as many calories. This is a major thesis of our new book.

      I think you’re eating quite well now, you could add a bit of carbs but it sounds as though you are very nearly perfect.

      Best, Paul

      • Wonderful, thank you! That’s what I needed to know. I can’t wait to read your new book, it sounds like it will have some good information in it.

  32. Hi Paul,

    I have a few questions about intermittent fasting:

    1. broadly speaking, the three big health benefits of IF are: autophagy, circadian rhythm enhancement, and growth hormone increase. is that right?

    2. assuming a waking period of 6am-10pm, does it matter which 8 hr feeding window is chosen as far as the impact on the big three benefits above? is 6am-2pm feeding window no better or worse than a 2pm-10pm window, etc.??

    3. how important, if at all, is it to keep the feeding window consistent from day to day?

    4. aside from coconut oil and coffee with cream, what else can be eaten during the 16 hr fasting window with minimal inhibition to the big three health benefits?

    thanks,

    kevin

    • Hi Kevin,

      1. Yes.

      2. I think it’s ideal if the feeding window fits into daylight hours for circadian rhythm reasons. Maybe finishing eating at sunset would be perfect.

      3. It’s helpful I think, also for circadian rhythm reasons.

      4. I’d think of it more as seeking countervailing benefits from the food that make up for any loss of fasting benefits. For instance, a bowl of berries might help improve gut flora. A bowl of bone broth with vegetables (tomato, spinach) might improve micronutrient status. A bit of protein might support muscle growth in a subsequent workout. Coconut oil supports ketosis, so it’s more in keeping with the fast, but in principle you are still getting some benefits of fasting if you just eat less than normally, even if you eat something.

  33. Hello again Paul,

    Was trying to find a specific post on this but only found posts somewhat related. What do you feel is the best way to get rid of rosacea? I have had it for all of my life and honestly do not think about it too much (I figured it would always be there so why worry about something I can’t change) but curious if it is possible to get rid of it. I follow your perfect health diet but am trying a more ketogenic approach at the moment to see how I like it. Going to cut out dairy as it causes the rashes on my leg. I don’t believe this will change my rosacea as I have cut out dairy before but curious on your thoughts on what could… if anything.

    Thanks, Jared!

    • Jared, my cousin has severe rosacea, she’s tried all sorts of diets to improve her condition. She’s gone on paleo too, and while it did prevent break outs, it didn’t make the rosacea go away. She always washes her face with cold water, doesn’t drink alcohol, avoids saunas and steam, is very diligent with her skin care and has gone to lots of dermatologists. She told me the only thing that helped was going to a vascular doctor to laser the redness and capillaries away.

    • Hi Jared,

      At the moment I have suspicions, more than knowledge. I believe our diet is best. My rosacea went away on our diet, then came back when I overdosed on selenium, and now is almost gone again. Some readers have reported rosacea cures.

      I suspect rosacea is related to imbalances among vitamin A related signaling molecules including thyroid hormone, CLOCK, vitamin D, and vitamin A. So, a healthy nourishing diet, with proper but not excessive amounts of nutrients, circadian rhythm therapies, low toxicity, and time should be the best strategy.

  34. Another H. Pylori question:
    My research has come up with a number of sources with “Do Not Eat” lists for H.P. that include white rice. I have come to rely on those nice little sushi rolls for my lunch. So, given what I have read here in the past, I believe that if I add plenty of butter to the rice, it won’t be as troublesome to my attempts to eradicate the H.P.

    Correct?

    • Hi Lana,

      The butter will prevent postprandial hyperglycemia. I don’t know why they think rice is especially dangerous, but if it is elevated blood glucose, then butter and sushi vinegar would help.

  35. I found it. No response needed. Used PeterC’s direction for using google and found the reference to white rice, dairy, butter, etc. Helpful. Thanks.

  36. I just figured out after months that what I thought was candida symptoms was low sodium. *eye roll*

    • Hi tam,

      Great! Glad you found an easy cure.

    • Low carb diets can cause the body to excrete minerals out of the body – including sodium. As well as potassium and magnesium. Carb levels above 100grams are needed to maintain mineral status in the body.

      Some people have died from heart failure because they were missing important electrolytes from their bodies.

      • I don’t think I went below 100 grams (150-200) last time I checked), but it certainly matches the symptoms. Are there infections that consume sodium too (or I needed more carbs because of an infection)? I test high for candida antibodies at least.

        I’ve gone through weird phases where my heart would race after oranges, vitamin c, milk and chocolate blended drinks, etc.

  37. “I’ll be appearing on Cary Nosler’s Wide World of Health on Sunday September 9 at 4 pm EDT/1 pm PDT, unless baseball playoffs interfere in which case it will be at 3 pm EDT/noon PDT.”

    Was that supposed to be October 9? It doesn’t appear that the site linked has been updated since may. Also, unless you’re a Red Sox fan (yes that was a dig! lol), Sept. 9 is too early to worry about who will be in the playoffs for baseball.

    I just want to make sure not to miss any shows/podcasts!!

    Thanks,

    Kevin

  38. Hi Paul,

    You have referenced Chinese herbs + detox aids as a good treatment for fungal infections. Can you specify which herbs you recommend? Despite my internet search for TCM’s take on treatments for fungal infections, I could find only topical treatments.

    Thanks,

    Lindsay

  39. Hi Paul. I know you’ve mentioned that eating .5-1lb salmon a week is good and that you can have non-oily fish in between. What non-oily fish do you recommend? Are there any specific kinds to avoid? Lastly, should I be concerned about the mercury content of fish?

    • Hi Corinne,

      That’s actually a tricky question and we haven’t settled on an answer yet. Wild fish high in the food chain have mercury risks; farm-raised fish have pollution- and feed-related risks; other wild fish may be expensive or their fishing unsustainable. In principle fish and shellfish should be extremely healthy, but the current food production system adds some uncertainty as to what is best.

      Re fish with mercury, the latest Around the Web links to a few posts elsewhere discussing the issue: http://perfecthealthdiet.com/2012/09/around-the-web-back-to-school-edition/. I think it’s an open question.

      • Thanks Paul, I’ll read the links. Do you have any general guidelines? Do you think eating fish like tilapia and tuna regularly between salmon and other oily fish is probably okay?

        • I don’t feel ready to give guidance. Tilapia is farmed and may be high in omega-6 fats. Tuna might have mercury. I’m willing to eat both in low doses but I would not consider either to be top choices.

          • Thanks for all the info you’ve provided, Paul. I’ll stick to wild-caught salmon a few times a week, shrimp and other shellfish, and some low-toxin/mercury non-oily fish.

  40. Dear Corinne,

    please have also a look on this if you like:
    http://www.greenpeace.org/usa/en/campaigns/oceans/seafood/red-fish/
    it is actually so connected the subjects perfect health/paleo and sustainability.
    that is one of the big advantages of these nutrition advises that they lead directly to the challenge how do we get fish and meat that are showing a good way of treating mother earth respectful and in the sense of taking care instead of we don’t eat meat so we are out of the responsibility…
    so indeed eating fish is more tricky and one needs to check what fish is acceptable to eat not just for our individual health but in a more holistic context. with warm regards, Gregor

  41. Hi Paul-
    A little info for those that might be interested…I am 68 yrs. old,and have been a heavy weight lifter most of my adult life.Recently,my lifting has produced a lot of muscle soreness and stiffness for a few months.So,I went to the local blood bank,donated blood,and within hours the pain and stiffness disappeared.It appears that my body’s ability to dump the excess iron has diminished over the years.Giving blood might be a good thing for yourself and for others.

  42. Hi Paul,

    Sorry in advance for the length, but I’ve new lab work I’d like to share. I’ve been following PHD since February. I’m 36, male, with depression and insomnia relating to chronic post-surgical pain and severe dry eyes/blepharitis following a bout of allergic conjuctivitis. Also high LDL. (The surgical pain is incurable. The eye pain is vexing, I’ve tried extended courses of anti-inflammatory drops/antibiotic drops with no relief, negative for demodex mites.) The three sets of labs I’d like to share concern thyroid, sex hormones and nutrient deficiencies.

    Iodine supplementation seems to have backfired a bit, despite my slow upward titration:
    September 2012, TSH=1.99, iodine 225mcg, free T4 1.62 ng/dl (range 0.82-1.77), free T3 3.5 pg/ml (range 2.0-4.4)
    June 2012, TSH=2.49, iodine 3mg
    April 2012, TSH=1.73, iodine 1mg
    October 2011 (pre PHD), TSH 1.37, no iodine

    It seems that your current advice is to treat subclinical hypothyroidism, but that with my free T3/4 in the upper ranges, there is nothing to treat. As for iodine, you prefer a min. dose of 225mcg, which I should stick with. Close? Would a salivary hormone kit make sense to test adrenal function? DHEA for andrenal fatigue?

    As to the sex hormones,
    September 2012, Total testosterone 915 ng/dl (range 348-1197), free T 18.3 pg/ml (8.7-25.1), sex-binding hormone 64 nmol/L (range 16.5-55.9).
    June 2012, Total T 606 ng/dl, free T 10.5 pg/ml, sex-binding hormone 81.5 nmol/l.
    This is a rather shocking increase in testosterone and my physique is starting to reflect it (former athlete). I attribute this to PHD and to my having added a zinc supplement. Any suggestions on reducing sex-binding hormone? I’m considering a nettle root supplement, increased protein and more consistent omega 3s might also help.

    As for nutrient deficiencies, a recent Spectracell test (lymphocyte culture) showed me as deficient in zinc, Coenzyme Q-10, and vitamin C. The C result is very odd because at the time of the test I was taking 5g per day. Per your suggestion I have previously tried titrating to bowel tolerance and stopped at 100g. I stuck with 100g/day for about three weeks but stopped because I was worried about pro-oxidant effects.

    I am hep/std negative. Metametrix came back negative. Candida blood and mouth culture (white tongue) also negative. Tumor necrosis factor 1.2 pg/ml (0.0-8.1). C-reactive protein 0.42mg/l. I have switched to your updated supplement recommendations. But any suggestions as to what I should do about C and antioxidants moving forward? Ideas for further infectious disease testing? (I have a very cooperative physician.)

    Finally I’m trying to incorporate your circadian rhythym strategies but many mornings am useless. Probably just need to push through.

    • Should add that I’m taking recommended melatonin 5 mg time-release with 1 mg sublingual.

    • Hi Shawn,

      I don’t know specifically what’s going on. The high C needs Cathcart associated with viral infections. The thyroid – do you have hyperthyroid symptoms? Some people have thyroid nodules and develop high thyroid hormone levels and hyperthyroidism with iodine supplementation. I would cut down on iodine; the 225 mcg/day might be a good dose. High testosterone I’m sure is meaningful but I don’t know how to interpret it.

      You didn’t describe symptoms, which might tell more, but I think your physician is in the best position to interpret those.

      Best, Paul

      • Paul,

        Thanks for your response. I do have a few hyperthyroid symptoms, including insomnia, anxiety, and shaky hands. But all of that predates iodine supplementation by years.

        Other symptoms include white patches on tongue, sore throat, low libido, brain fog. Cathcart also associated high C tolerance w/fungal infections, but all the candida tests have come back negative and so I’m hesitant to treat (say w/antifungals/lufenuron).

        I will report back if my doctor has any useful ideas, esp. regarding viral and other ID testing.

  43. Hi Paul,
    I like making sauces and desserts with nut butters and roasted nuts (the lower omega-6 ones). Are store-bought roasted nuts and nut butters PHD-friendly? Or should I make my own a la Weston Price (by soaking them first and then drying the nuts in the oven at a low temperature)?

  44. Hi Paul,
    a short question: An acquaintance of mine has tried eating two boiled eggs in the evening without any carbohydrates. She is not (yet) aware of the PHD ( – a pity that your book has not yet been translated into German, since quite a few friends of ours can’t read it… – ) and I only told her about our increased egg consumption. So she tried eating eggs and felt quite full and a bit like numbed for half an hour. Now she asked me if there was a way to help digestion of the eggs…and that’s my question to you! What should I tell her?
    Thanks a lot for taking time to answer such questions…
    Marion from Berlin

    • Hi Marion,

      Usually it is the protein in eggs that causes trouble, and it is mostly in the white. So I would try eating the yolks only. If she wants whole eggs, she could try eating more salt and, if that doesn’t work, taking a betaine hydrochloride tablet with the eggs.

  45. Hi Paul, I wrote you previously about GAPs, heat hives, adult acne, getting more carbs etc. I decided to try some rice last night, about 1/2 cup dry. I felt great right after dinner, but 3 hours later I was doubled over with lower abdominal pain and nausea. What do you make of this…was it possibly just too much at once or might I have a pathogen that is indeed fed by starch? I did also have about 2 cups of canned pumpkin with some coconut oil…I have eaten a whole can before and noticed my stomach got a little rumbly so Im not sure if maybe it was just a bad interaction.

    What do you think of biokult? I have intermittent post nasal drip and I have suspected either broth or ferments. I took a small portion of biokult a little after dinner the other night, and the next morning I had a bowel movement that looked very…mucusy I think…this weird wavey white stuff. Thank you!

    • Hi Elyse,

      It does sound like something in the colon. Three hours would be about right for the food to reach there.

      People have had very inconsistent results with probiotics including BioKult, and I don’t know how the makers control the quality. Live cultures are just that, and bacteria are highly variable, they exchange DNA, slight contamination can turn a probiotic strain into a pathogenic one. I lean more toward making fermented mixed vegetables at home, then you have better control of what species will show up, and the range of species is broader as well.

      • Do you think I should continue to try eating rice just maybe smaller portions?

        Also what about the translucent whitish stuff in my stool? Thanks again Paul, can’t wait for the new book!

  46. I just got the following health newsletter from “Juvenon.” a company affiliated with a lot of top researchers, including Dr. Bruce Ames. (I ordered some of their flagship product a while ago, do not take now.) This sentence jumped out at me: “A high fat diet has a harmful effect on metabolism as it impairs the capacity of cells, especially liver, fat and muscle cells, to remove glucose from the blood. This is due to the decreased ability (desensitization) of the cell receptors to take up glucose in response to insulin.”
    http://juvenon.com/jhj/vol11no7w.htm
    This kind of thing fuels me nervousness at going against mainstream advice….
    (I trust my question is implicit.)

    • Hi Jamie,

      Insulin resistance is more connected to total calorie intake than to fat intake. On bad diets you eat extra calories and become insulin resistance; on healthy nourishing diets, including majority-fat diets, total calorie intake goes down and you become insulin sensitive.

      PHD is quite good at creating nourishment with minimal calories, that’s what we designed it to do. Check out our reader results page, http://perfecthealthdiet.com/reader-results-by-condition/#Obesity, for reader accounts of reduced appetite.

  47. Hi Paul,

    I just wanted to clarify a couple of things in regards to making PHD ketogenic for treating depression (Or diagnosing its cause).
    How long should you do it for to see what the effects are on depression?

    I will be consuming a normal amount of PHD carbs (More on weight training days after training) and want to maintain ketones – Will 12 tablespoons of Coconut oil do it? More? or in relation to depression should carbs be kept low?
    Is timing of taking the coconut oil important throughout the day?

    Along with the coconut oil consumption should I also consume lysine? leucine? BCaa’s? All of them? – How much of each per day and is timing important for those too?

    Thanks Paul, I really want to get it right.

  48. Hi Paul, I’ve been gone from you site for a while, reading and gaining more and more knowledge from other Paleo experts. I heard your show with Sean Croxton and remembered how much I love you, your book and info. A while back you said that you were going to write a recipe book due out last Spring if I remember correctly. Did that ever happen?

    • Hi Isa,

      No, the cookbook is something we’ll be returning to shortly. We got diverted into doing a revised edition of our first book, to come out in December. We will aim to get a mobile/iPad app out and then a cookbook next year.

  49. Anyone
    Does anyone have a PHD approved Green Smoothie recipe. I’ve been hooked on Green Smoothies for a while now and I pile a large amount of raw greens into my Vitamix but now I’m wondering if that might not be a good idea considering what Paul says about toxicity. I looked in the recipe section but none there that I can see. thanks so much

  50. This helps a lot. I’ve been using http://cronometer.com/ to track my food most days and have trouble keeping carbs down. But if leafy greens aren’t counted that makes a big difference. I also add about 150 grams of carrots and an organic apple as well as some Skinny B (http://holycrap.ca/product/skinny-b-cereal/) and some Flax Oil.

    I was listening to Ben Greenfield today and went and purchased some cod liver oil only to find that Paul is not convinced it is helpful (may be harmful) 😥 )ne Guru at a time I guess 😉

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